Workers compensation is a unique insurance system that provides benefits to workers who sustain injuries on the job. The benefits, paid for by employers’ insurance companies, help employees pay for their work injury-related medical bills and stay afloat financially until they can return to work. The application process can be complicated, so workers should speak with a Charlotte workers comp lawyer to ensure they do not accidentally thwart their rights to benefits.
Below, we provide a brief summary of some of the key aspects of workers compensation in North Carolina. For legal help in the Charlotte area, you are welcomed to call Ted A. Greve & Associates, P.A. and request a free work injury case evaluation at 800-375-9190.
Why do I need a workers compensation attorney, and how does the workers compensation system operate?
Workers compensation was put into place to provide certain protections for both employers and employees. Prior to the Industrial Revolution and workplace reform, if a worker was hurt on the job, he was pretty much out of luck. There were no benefits to lean on if a worker became disabled and there was no guarantee of medical care. Employers would just quickly find a replacement worker and move on.
Thankfully, federal and state laws now offer much needed protection for employees. Workers’ compensation functions as a financial safety net so that if ever you sustain injuries at work, you will have guaranteed, albeit temporary support.
The way the system works is fairly straightforward. You sustain injuries on the job or develop an occupational illness, file a claim, and receive benefits until you are able to return to work. And fault does not come into play in when it comes to workers compensation claims. This no-fault system means that even if you are to blame for the accident and accidentally injure yourself, you can still retain your rights to benefits.
Employers also benefit because under workers compensation laws, employees cannot sue their employers for most work-related injuries. It is a trade-off:
- You essentially trade your right to sue in exchange for certain guaranteed benefits.
- Employers are legally bound to pay employee benefits, but in return, they enjoy limited liability because employees cannot sue them.
What types of injuries qualify for workers’ compensation?
According to the Bureau of Labor Statistics (BLS), 1,157,410 employees sustained a work injury serious enough to miss days at work in 2014. Workers had to miss work an average of nine days because of their injury, a substantial amount of downtime, the BLS reports.
So do all of these injuries qualify workers for benefits? In the majority of cases, yes. Workers compensation laws provide that all types of injuries that employees sustain during the scope and in the course of their employment are compensable under workers compensation. The same goes for illnesses that workers develop as a result of work conditions. If you develop cancer because of exposure to asbestos, for instance, your condition should qualify you for benefits.
It is important to note that your injuries do not have to result from a sudden, one-time accident in order to be covered. Some conditions take time to manifest and yet, so long as they are work-related, they are still compensable. Exacerbations of old injuries can qualify you, as can repetitive motion and overuse injuries.
The most common type of injury workers sustain on the job is musculoskeletal injuries, which account for about a third of all cases, according to the BLS. Many of these injuries involve sprains, strains, and tears. Other examples of types of injuries that workers compensation covers include those related to:
- Slips, trips, and falls
- Bodily reaction (when employees react to a situation and sustain injuries as a result, such as trying to catch yourself from falling only to pull down a bookshelf on top of yourself)
- Overuse/repetitive strain injuries like carpal tunnel syndrome
- Being caught in between two objects
- Falling objects
- Shocks and electrocution
- Work-related auto accidents
- Fires, explosions, and other burn incidents
- Collapsed buildings and structures
- Exposure to toxic chemicals and substances
- Acts of violence, including attacks from outside perpetrators, customers, and coworkers
- Machinery and tools
What types of benefits does workers compensation provide?
Each state determines its own specific laws regarding workers compensation. In North Carolina, workers have access to four types of benefits:
Your employer’s insurer should pay all of your reasonable and necessary medical bills related to your work injury or disease. This includes those for emergency care, surgeries, hospital expenses, nursing care, rehabilitative services, prescriptions, and medical care-related transportation.
You will also be entitled to weekly wage replacement benefits if you have to take time off work. Benefits will be calculated at two-thirds of your average pre-injury weekly wages. You do not qualify for income benefits unless you miss more than seven days of work. Your first seven days are only compensable if you miss more than 21 days.
Also, your weekly income check cannot exceed the state’s maximum, which, in 2016, is $944/week. The North Carolina Industrial Commission (NCIC) adjusts the maximum weekly rate changes yearly.
There are actually several distinct types of income benefits available under workers’ compensation, each pertaining to each different kind of situation. These include temporary partial disability (TPD), temporary total disability (TTD), permanent partial disability (PPD), and total permanent disability (TPD). Your case worker or Charlotte workers compensation lawyer can explain in greater detail what types of benefits you have access to.
If are not able to return to your old job or you are earning less than 75 percent of your prior income because of your injury, you have access to vocational rehabilitation services, too.
In G.S. § 97-32.2(d), NC laws provide that vocational rehabilitation services can include “vocational assessment, vocational exploration, sheltered workshop or community supported employment training, counseling, job analysis, job modification, job development and placement, labor market survey, vocational or psychometric testing, analysis of transferable skills, work adjustment counseling, job seeking skills training, on‑the‑job training, or training or education through the North Carolina community college or university systems.”
When employees die as a result of a work accident or illness, their families are entitled to death benefits. These include two-thirds of the deceased’s pre-injury average weekly wages for 500 weeks, as well as funeral expenses up to $10,000.
What are common challenges to workers’ compensation claims?
If you are getting ready to file or are in the midst of a workers compensation case, be aware that there is a good chance you will run into hurdles along the way. It is not uncommon for workers to come across challenges in the process or find that their employers have denied their claims.
In some cases, the denials are justified. For instance, if an employee’s injuries resulted from drug or alcohol intoxication, horseplay on the job, or were purposefully self-inflicted, then he is not entitled to benefits.
Other times, denials result from inadvertent mistakes on the employee’s part. Some of the most common ways employees thwart their rights to benefits are by overstepping the time limits on notifying their employer of their injury, not having enough proof to show the injury was work-related, making errors on forms, and not following through with their treatments.
Workers’ comp insurers are not immune to mistakes, either. While many insurance companies handle claims ethically, they also tend to carefully scrutinize and routinely challenge claims, screening for ways to deny them or reduce the payouts. They are, after all, a for-profit business and need to be mindful of their bottom line. Below are some of the ways the insurer may challenge your claim.
- They may say your injury is fabricated or exaggerated.
- They may say your injury was pre-existing.
- They may say that your injury or illness is not work-related.
- They may say that you are capable of returning to work, even when you do not think you are.
- They may say you are an independent contractor (which would make you ineligible for workers compensation), even if you meet the legal definition of employee.
What do I do if my employer denies my claim?
If your employer denies your claim, the first thing you will need to do is consult with a workers’ compensation lawyer in Charlotte for help, if you have not done so already. You do not want to risk losing your rights to benefits simply because you are not familiar with legal protocols. Employees fair far better when they are represented by counsel. Your lawyer can help you appeal the claim and use the opportunity to fight for the benefits you deserve.
You can then appeal your denial with the NCIC. There are three levels of appeals for North Carolina workers compensation claims:
Level one: If your employer denies your initial claim for benefits, you can request a mediation conference with the NCIC. To make the request, you will have to submit Form 33, Request for Hearing to the NCIC within two years after the date of your injury.
Mediation is a way of settling claims, sans the costly litigation expenses. An unbiased mediator will be present at the meeting, which both parties and their counsel attend. You will have a chance to present evidence to support your claim. At the end of the meeting, the mediator will offer recommendation and try to facilitate an agreement.
Level two: If you and your employer/insurer still cannot reach terms, you can request a formal hearing with the NCIC. This is much like a normal trial; an administrative law judge (ALJ) will hear your case, and both parties can present evidence and call witnesses. Again, your goal will be to attempt to justify your rights to benefits. The judge will provide a decision at the end of the hearing.
Level three – If the ALJ denies your claim, you have one final option: a request a hearing with the North Carolina Court of Appeals. Your workers comp attorney can explain if this is a good option for you, and help you navigate the process.
Where can I find assistance and advice for obtaining benefits?
Your best resource for advice with workers comp claims is a law firm that specifically handles claims of this nature. A workers compensation lawyer can help with all aspects of the claims process, from initial claim to appeal, and ensure you get the full amount of benefits that you are entitled to.
A Charlotte workers compensation lawyer can work with the insurance company, help gather evidence to support your claim, check forms for accuracy and thoroughness, and appeal your claim if your employer’s insurer has denied it.
The work injury attorneys at Ted A. Greve & Associates, P.A. provide free consultations to injured workers and their families. We have over two decades of experience helping people in Charlotte get the benefits they need and deserve after serious work-related incidents. We would be happy to help you too.
If you have sustained a workers compensation accident, it would be best to seek immediate medical attention. Major hospitals and other medical facilities in Charlotte, North Carolina include:
- Carolinas Medical Center – 1000 Blythe Boulevard, Charlotte, NC 28203-5871 / (704) 355-2000
- Presbyterian Hospital – 200 Hawthorne Lane, Charlotte, NC 28204-2528 / (704) 384-4000
How can Ted A. Greve & Associates, P.A. help?
Contact us today at 800-375-9190 to get started.